Chad Wable, a veteran health care executive and consultant, has spent decades leading operational turnarounds and advancing performance improvement across hospitals and health systems. Through his work with AspireResults, where he serves as president, he has guided organizations through complex challenges involving financial strategy, workforce optimization, quality, and community engagement. Earlier in his career, Chad Wable held senior leadership roles within large regional systems, overseeing operations, IT modernization, and organizational design initiatives. His experience extends to advising companies on benefits and care delivery strategies, with a focus on improving outcomes in an environment marked by rising costs and inefficiencies. Given the increasing strain on public health funding, his background offers context for understanding the pressures modern hospitals face and the need for innovative approaches to sustain care delivery in the United States.
Finite Government Support – A Challenge for Modern Hospitals
Hospitals in the United States are facing a major obstacle: limited government support for public health programs. Budget cuts and shifting political priorities have led to underfunded public health systems and weakened prevention infrastructure. As a result, hospitals are increasingly left to manage the long-term consequences. To adapt and lead effectively, hospitals must find innovative ways to fill the gaps left by diminishing public health investment.
Most federal government funding for public health is channeled through the Centers for Disease Control and Prevention (CDC), from where it goes to states, territories, and tribes. Unfortunately, Trust for America’s Health found that the CDC’s budget in FY 2024 was three percent lower than FY 2023. Longer term, adjusted for inflation, the budget had only risen by four percent from FY 2014 to FY 2024.
At the state level, the situation is equally worrying. State public health budgets, when adjusted for inflation, fell in 25 states from 2010 to 2021.
Another report released in 2025 by the American Hospital Association (AHA) spotlighted the rising rate of Medicare and Medicaid underpayments to hospitals. AHA found that in 2023, Medicare reimbursed hospitals only 83 cents for every dollar’s worth of care they delivered to patients. That same year, hospitals absorbed $130 billion in Medicare and Medicaid underpayments. It further found that the shortfalls were rising at a rate of 14 percent per year, from 2019 to 2023.
Legislative changes are also expected to compound the funding problems of healthcare systems. An example is the passage of the One Big Beautiful Bill Act, which is projected to reduce Medicaid and other program payments by $1 trillion.
These funding challenges are having a detrimental effect on America’s public health sector. Many hospitals are being forced to reduce critical staff or services to stay afloat. Others are reducing investments in disease research, while others are putting off capital expenditure investments. This includes investments in modernizing hospital infrastructure, servicing testing equipment, or increasing bed count.
The result of all these is a brittle national health system that is not well equipped to fight existing challenges, such as the high prevalence of chronic disease in the country, as well as emerging challenges, such as an aging population and mental health crises. The hospitals are also not able to adequately prioritize proactive public health interventions, relegating them to the reactionary role of treating diseases. Notably, some healthcare systems, such as hospitals in rural areas and those serving economically disadvantaged populations, are disproportionately affected.
Beyond cutting costs, what can healthcare systems do to overcome the funding challenges they face? Some are expanding their services, going beyond general care to offer specialty care too. This, they expect, will help them cater to a broader population, opening additional income streams. Others are partnering with private organizations, academic institutions, and nonprofits to fill service gaps, while others are collaborating with community organizations to co-develop interventions. The latter prevents duplication of services, allowing hospitals to stretch out limited resources.
Another option the American College of Healthcare Executives has noted hospitals taking is implementing programs that address the determinants of public health. For example, they are integrating hospital-sponsored food security and housing programs to address issues such as inadequate nutrition and homelessness. They are also promoting access to health-related information to educate their communities on ways of preventing illness.
A final action hospitals can take is advocacy. Hospitals are powerful stakeholders in the healthcare ecosystem, and their collective voice carries weight. Hospital leaders can use their influence to advocate for sustainable funding and evidence-based policy reforms. They can engage with policymakers, participating in health coalitions and presenting data that demonstrates how investments in public health reduce overall healthcare costs and lead to stronger, more stable societies.
About Chad Wable
Chad Wable is an experienced health care leader who has guided hospitals and health systems through operational, financial, and strategic challenges. As president of AspireResults, he advises organizations on margin improvement, risk management, and workforce performance. His background includes senior leadership roles in regional health systems where he oversaw operations, IT advancement, and service expansion. He has supported innovation efforts, community initiatives, and organizational transformation, while also contributing to nonprofit and advisory boards.
